Individual
AMONI DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
128 HOLLYBERRY CT, DALLAS, GA 30157-6103
(202) 329-0015
Mailing address
128 HOLLYBERRY CT, DALLAS, GA 30157-6103
(202) 329-0015
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
GA
Other
Enumeration date
05/24/2021
Last updated
05/24/2021
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